Age-Related Differences in the Etiology and Clinical Characteristics of Uveitis in Japan: A Retrospective Comparative Study.

[PURPOSE] To investigate age-related differences in the clinical characteristics and etiologic distribution of uveitis.

[METHODS] We retrospectively analyzed 1190 consecutive uveitis patients, stratified into a younger group (<65 years,  = 720) and an older group (≥65 years,  = 470). Demographic variables, laterality, anatomic classification, pathological classification, and etiologic diagnoses were compared between age groups. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and age-related associations were visualized using forest plots.

[RESULTS] Infectious uveitis was significantly more frequent in older patients than in younger patients (31.3% vs. 14.0%; OR 2.79,  < 0.001), whereas noninfectious uveitis predominated in younger patients. Granulomatous inflammation was also more common in older patients (OR 2.50,  < 0.001). Among noninfectious entities, acute anterior uveitis, Behçet disease, diabetic iritis, and tubulointerstitial nephritis and uveitis syndrome were significantly more prevalent in younger patients, whereas malignant lymphoma was more frequent in older patients (OR 7.01,  = 0.010). Among infectious etiologies, herpetic anterior uveitis, endophthalmitis, cytomegalovirus retinitis, and infectious uveitis of unknown cause were significantly associated with older age. Subtype analyses revealed that posterior and necrotizing scleritis occurred exclusively in older patients, and that varicella-zoster virus anterior uveitis was significantly associated with older age.

[CONCLUSIONS] Uveitis exhibits a marked age-dependent shift in etiology, from immune-mediated, noninfectious diseases in younger patients to infectious and neoplastic conditions in older patients. These findings highlight the importance of incorporating age into the diagnostic and therapeutic approach to uveitis.